Clinical outcomes in patients with stage I non-seminomatous germ cell cancer

Abstract

This study assesses the long-term outcomes in Han Chinese patients with clinical stage I non-seminomatous germ cell testicular cancer (CSI NSGCT) treated with surveillance, retroperitoneal lymph node dissection (RPLND) and adjuvant chemotherapy. We retrospectively evaluated 89 patients with a mean age of 26.5 years. After orchiectomy, 37 patients were treated with surveillance, 34 underwent RPLND and 18 were managed with chemotherapy. The overall survival rate, the recurrence-free survival rate and the risk factors were evaluated. The median follow-up length was 92 months (range: 6-149 months). Thirteen of the 89 patients (14.6%) had relapses, and one died by the evaluation date. The overall survival rate was 98.9%. The cumulative 4-year recurrence-free rates were 80.2%, 92.0% and 100% for the surveillance, RPLND and chemotherapy groups, respectively. The disease-free period tended to be briefer in patients with a history of cryptorchidism and those with stage Is. Therefore, surveillance, RPLND and adjuvant chemotherapy might be reliable strategies in compliant patients with CSI NSGCT. Surveillance should be recommended for patients with the lowest recurrence rate, especially those without lymphovascular invasion. This study might aid the establishment of a standard therapy for CSI NSGCT in China.

Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

“…Both regimens are category 1 recommendations, and either is preferable to initial RPLND because these patients nearly always have disseminated disease. 82,83…”

Testicular choriocarcinoma in a case of inguinal hernia: a rare subtype of non-seminomatous mixed germ cell tumour with a misleading presentation requiring a unique treatment approach

“…Either 3 cycles of BEP or 4 cycles of EP are preferable treatments because the majority of these patients have disseminated disease. [15][16][17] Thus if the tumor markers remain high after orchiectomy; adjuvant chemotherapy remains the hallmark of treatment. After chemotherapy, tumor markers should be assessed until they are normal, as long as they follow their half-life kinetics and no metastases are revealed.…”

“…Semen analysis and sperm banking should be offered for all young males before chemotherapy. [11][12][13][14][15][16][17][18][19][20] A testicular prosthesis could be implanted in the scrotum, to provide a normal look. The prosthesis approved for use in the United States is filled with saline (saltwater) and comes in different sizes to match the remaining testicle.…”

Testicular germ cell tumours’ clinical stage I: comparison of surveillance with adjuvant treatment strategies regarding recurrence rates and overall survival—a systematic review

“…There are no prospective randomized controlled trials comparing carboplatin monotherapy with surveillance in CSI SE patients. Survival data and recurrence rates after adjuvant carboplatin therapy are only available from multi-arm [14] 2017 Retrospective cohort study 2 × BEP 1992-2017 184 1.1% Ondrus [15] 2015 Prospective cohort study 2 × BEP 1992-2014 167 1.2% Kobayashi [12] 2013 Retrospective cohort study 1980-2008 4 0% Lv [16] 2013 Retrospective cohort study 2 × BEP 1997-2011 18 5.6% Tandstad [17] 2010 RCT prospective cohort studies and from a large number of retrospective single-arm studies. Concerning disease free survival, the 3 years' disease free rate after two courses of carboplatin monotherapy is 98.0% (95% CI 94.0-100%) [30].…”